Vaginal Cancer: Epidemiology and Risk Factors

  • Rani Bhat


In situ or invasive vaginal cancer is diagnosed in approximately 1 in 1 lakh women across the globe with a mean age of 60 years for squamous cell cancer. Women may occasionally present in the second or the third decade. Most of the vaginal cancers in young women are primarily HPV related though the other causes could be diethylstilbestrol (DES) exposure, vaginal adenosis, previous radiation therapy, smoking, and HIV/AIDS. Malignancy can be either primary or metastasis from adjacent or distant organs. Primary vaginal cancers are defined as arising solely from the vagina, with no involvement of the ecto-cervix or the vulva distally. According to the International Federation of Gynecology and Obstetrics (FIGO), a vaginal lesion involving the cervix should be managed as a cervical cancer; a tumor involving both the vulva and the vagina should be considered as a primary vulvar cancer. About 80% of vaginal cancers are metastatic with primaries being the cervix or the endometrium and less common sites being the vulva, ovaries, choriocarcinoma, rectosigmoid, and bladder. Metastasis through the blood or lymphatic system can also occur from colon cancer, renal cell carcinoma, melanoma, and breast cancer.


Vaginal cancer HPV infection VaIN Epidemiology Incidence Risk factors DES exposure 


  1. 1.
    Yagi A, Ueda Y, Kakuda M, Tanaka Y, Egawa-Takata T, Morimoto A, et al. Descriptive epidemiological study of vaginal cancer using data from the Osaka Japan population-based cancer registry: long-term analysis from a clinical viewpoint. Medicine (Baltimore). 2017;96(32):e7751. Scholar
  2. 2.
    American Cancer Society. Key statistics for vaginal cancer. Available from: Accessed 20 Apr 2018.
  3. 3.
    Cancer Research UK. Vaginal cancer statistics. Available for: Accessed 20 Apr 2018.
  4. 4.
    Dixit S, Singhal S, Baboo HA. Squamous cell carcinoma of the vagina: a review of 70 cases. Gynecol Oncol. 1993;48:80–7.CrossRefGoogle Scholar
  5. 5.
    Hellman K, Silfversward C, Nilsson B, Hellstrom AC, Frankendal B, Pettersson F. Primary carcinoma of the vagina: factors influencing the age at diagnosis. The Radiumhemmet series 1956-96. Int J Gynecol Cancer. 2004;14:491–501.CrossRefGoogle Scholar
  6. 6.
    Carter JJ, Madeleine MM, Shera K, Schwartz SM, Cushing-Haugen KL, Wipf GC, et al. Human papillomavirus 16 and 18 L1 serology compared across anogenital cancer sites. Cancer Res. 2001;61:1934–40.PubMedGoogle Scholar
  7. 7.
    Daling J, Madeleine M, Schwartz S, et al. A population-based study of squamous cell vaginal cancer: HPV and cofactors. Gynecol Oncol. 2002;84:263–70.CrossRefGoogle Scholar
  8. 8.
    Daling JR, Sherman KJ. Relationship between human papillomavirus infection and tumours of anogenital sites other than the cervix. In: Munoz N, Bosch FX, Shah KV, Meheus A, editors. The epidemiology of human papillomavirus and cervical cancer (IARC scientific publication no. 119). Lyon: IARC; 1992. p. 223–41.Google Scholar
  9. 9.
    Brinton LA, Nasca PC, Mallin K, Schairer C, Rosenthal J, Rothenberg R, et al. Case-control study of in situ and invasive carcinoma of the vagina. Gynecol Oncol. 1990;38:49–54.CrossRefGoogle Scholar
  10. 10.
    McFarlane MJ, Feinstein AR, Horwitz RI. Diethylstilbestrol and clear cell vaginal carcinoma. Reappraisal of the epidemiologic evidence. Am J Med. 1986;81:855–63.CrossRefGoogle Scholar
  11. 11.
    Franco EL. Epidemiology of anogenital warts and cancer. Obstet Gynecol Clin N Am. 1996;23:597–623.Google Scholar
  12. 12.
    Merino MJ. Vaginal cancer: the role of infectious and environmental factors. Am J Obstet Gynecol. 1991;165(4 pt 2):1255–62.CrossRefGoogle Scholar
  13. 13.
    Srodon M, Stoler MH, Baber GB, Kurman RJ. The distribution of low and high-risk HPV types in vulvar and vaginal intraepithelial neoplasia (VIN and VaIN). Am J Surg Pathol. 2006;30:1513–8.CrossRefGoogle Scholar
  14. 14.
    Hampl M, Sarajuuri H, Wentzensen N, Bender H, Kueppers V. Effect of human papillomavirus vaccines on vulvar, vaginal, and anal intraepithelial lesions and vulvar cancer. Obstet Gynecol. 2006;108:1361–8.CrossRefGoogle Scholar
  15. 15.
    Parkin D, Bray F. The burden of HPV-related cancers. Vaccine. 2006;24(suppl 3):S11–25.CrossRefGoogle Scholar
  16. 16.
    Ikenberg H, Runge M, Goppinger A. Human papillomavirus DNA in invasive carcinoma of the vagina. Obstet Gynecol. 1990;76(3 Pt 1):432–8.PubMedGoogle Scholar
  17. 17.
    Ostrow RS, Manias DA, Clark BA. The analysis of carcinomas of the vagina for human papillomavirus DNA. Int J Gynecol Pathol. 1988;7(4):308–14.CrossRefGoogle Scholar
  18. 18.
    Castle PE, Schiffman M, Bratti MC, Hildesheim A, Herrero R, Hutchinson ML, et al. A population- based study of vaginal human papillomavirus infection in hysterectomized women. J Infect Dis. 2004;190:458–67.CrossRefGoogle Scholar
  19. 19.
    Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. Lancet. 2007;370:890–907.CrossRefGoogle Scholar
  20. 20.
    Lee YC, Holcomb K, Buhl A. Rapid progression of primary vaginal squamous cell carcinoma in a young HIV-infected woman. Gynecol Oncol. 2000;78(3 Pt 1):380–2.CrossRefGoogle Scholar
  21. 21.
    Benedet JL, Murphy KJ, Fairey RN, Boyes DA. Primary invasive carcinoma of the vagina. Obstet Gynecol. 1983;62:715–9.PubMedGoogle Scholar
  22. 22.
    Peters WA III, Kumar NB, Morley GW. Carcinoma of the vagina. Cancer. 1985;55:892–7.CrossRefGoogle Scholar
  23. 23.
    Rubin SC, Young J, Mikuta JJ. Squamous carcinoma of the vagina: treatment, complications, and long-term follow-up. Gynecol Oncol. 1985;20:346–53.CrossRefGoogle Scholar
  24. 24.
    Cogliano VJ, Baan R, Straif K, Grosse Y, Lauby-Secretan B, El Ghissassi F, et al. Preventable exposures associated with human cancers. J Natl Cancer Inst. 2011;103(24):1827–39.CrossRefGoogle Scholar
  25. 25.
    Herman JM, Homesley HD, Dignan MB. Is hysterectomy a risk factor for vaginal cancer? JAMA. 1986;256(5):601–3.CrossRefGoogle Scholar
  26. 26.
    Hellman K, Silfversward C, Nilsson B. Primary carcinoma of the vagina: factors influencing the age at diagnosis. The Radiumhemmet series 1956-96. Int J Gynecol Cancer. 2004;14(3):491–501.CrossRefGoogle Scholar
  27. 27.
    Sillman FH, Fruchter RG, Chen YS, Camilien L, Sedlis A, McTigue E. Vaginal intraepithelial neoplasia: risk factors for persistence, recurrence, and invasion and its management. Am J Obstet Gynecol. 1997;176:93–9.CrossRefGoogle Scholar
  28. 28.
    Cunha GR. The dual origin of vaginal epithelium. Am J Anat. 1975;143:387–92.CrossRefGoogle Scholar
  29. 29.
    Blomberg M, Friis S, Munk C, Bautz A, Kjaer SK. Genital warts and risk of cancer: a Danish study of nearly 50 000 patients with genital warts. J Infect Dis. 2012;205(10):1544–53.CrossRefGoogle Scholar
  30. 30.
    Cao L, Tong H, Xu G, Liu P, Meng H, Wang J, et al. Systemic lupus erythematous and malignancy risk: a meta-analysis. PLoS One. 2015;10(4):e0122964.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Rani Bhat
    • 1
  1. 1.Department of Gynaecological OncologyHealthcare Global Enterprises Ltd.BangaloreIndia

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